How Loud is Minimally Invasive Spine Surgery? Identifying Intraoperative Risk of Hearing Loss

Study DesignProspective Cohort Study.ObjectivesThe aim of this study was to assess how sound pressure levels (SPL) change throughout spine procedures and which phases may place surgeons at higher risk of noise induced hearing loss.MethodsSPL was recorded by a microphone attached to the surgeon's collar beneath the sterile gown for 6 of each: MI-TLIF, microdiscectomy, decompression. dBA was recorded every second. An overall average (ADL) and maximum (MDL) for each phase of the procedure were calculated and compared across procedure type. The ADL and MDL of two electric burrs and one pneumatic burr were collected and compared.ResultsADLs were significantly different for all three procedure types. There was no difference in the mean MDL (mMDL) between phases within each procedure type. The irrigation/closure phase had the lowest ADL and mMDL for all three procedure types. In MI-TLIF, facetectomy had a significantly greater ADL than all other phases; the highest mMDL was during the exposure phase. In microdiscectomy, laminotomy had the greatest mMDL, and ADL and was significantly higher than all other phases except exposure. In decompression, the laminectomy phase had the highest ADL and mMDL. The brand A-e burr had a significantly lower ADL and the lowest MDL.ConclusionDuring common spine surgery procedures, phases involving powered instruments such as burrs, electrocautery machines or suction had higher ADL and mMDL. Sound levels in the OR may peak above 85 dBA for short periods despite the average being below dangerous levels. Therefore, while surgeons are not usually at an elevated risk of NIHL, periods of elevated dBA warrant attention for elevated risk.